- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.59 / $253.81 / $672.19
| Professional | | $101.59 | $253.81 | $672.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.25 / $566.33 / $6,306.00
| Facility | | $238.25 | $566.33 | $6,306.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.27 / $600.19 / $1,908.09
| Facility | | $248.27 | $600.19 | $1,908.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |